[Marketing as an effective tool to overcome systems problems in the organization of antituberculous care to the pediatric population].

The paper analyzes the efficiency of vaccination and tuberculin diagnosis in the megapolis on the basis of official reporting forms Nos. 8 and 33 approved by the 11 November, 2005 Resolution of the Russian Statistics Agency and the Moscow tuberculosis monitoring system. It is concluded that refusals to undergo vaccination and tuberculin diagnosis may result in the system crisis of antituberculous care to the pediatric population. For the optimum solution of reducing the rate of refusals to take the drugs prescribed by a physician, the authors propose to use in pediatric antituberculous care the marketing methods that level off the responsibility of the parties in taking a decision whether a medical service is expedient. Under the marketing conditions of medical services, combating the foci of tuberculous infection should be a main line to reduce the prevalence of tuberculosis. Prevention of tuberculosis is most effective with the active interaction of medical services (pediatric phthisiological and primary pediatric care services) and society and with the needs being molded in it (as a market medical service) in the population.

[Detection of tuberculosis in Moscow adolescents].

Retrospective analysis of the data available in the reporting form 0-89/y-[cyrillic letter: see text] and information analytical tables for Moscow tuberculosis monitoring) over 7 years on all notified new cases of tuberculosis among 15-17-year-old children has indicated that it is necessary to change the procedure for detecting tuberculosis for this age group of children in order to improve the early diagnosis of the disease. The Mantoux test is likely to be rather effective in examining adolescent schoolchildren and students from secondary specialized establishments and ineffective among unorganized young people and in migrants' families. Planned fluorography is of rather informative value in all the groups under study if there is a timely referral for examination. The authors consider whether it is worth making a tuberculosis 2 TE PPD-L in organized collective bodies (schools, colleges, etc.). Other groups of children may undergo only digital small-dose fluorography. Unorganized children above 10 years of age who lack annual Mantoux test results must be referred for digital small-dose fluorography. Refusal to undergo fluorography is justifiable only if there is no tuberculin sensitivity or evident symptoms of intoxication. In the megapolis, due to uncontrolled migration, a lawmaker must consolidate the statute on that mandatory control should be exercised over 15-17-year-old adolescents who must undergo fluorography during their each visit to a health care facility, on entering an educational establishment, or on employment. On consulting a physician, the adolescent who has undergone fluorography 6 months before must have it again.

[Tuberculin diagnosis in children. Latent tuberculosis?].

The 2000-2006 results of tuberculin diagnosis made in a city numbering 10.5 million people were retrospectively analyzed on the basis of an epidemiological tuberculosis survey among children. The higher cut-offs are not helpful in interpreting the tuberculin test. With more than 5 mm, it is necessary to have criteria for clear differences between the active tuberculous process, inactive tuberculous changes, and recent or previous Mycobacterium tuberculosis infection. With the low prevalence of tuberculosis among children in a megapolis, the sensitivity of the method was 97.4%. Its specificity was 41.7%; out of these children, a risk group forms in 1% of cases and the children who had been referred by a pediatrician and had failed to be examined by a specialist at a tuberculosis dispensary. With positive and negative tests, the likelihood of the disease in a child is 0.01 and 99.9%, respectively. At the same time, morbidity in risk group children formed by the results of tuberculin tests is high and indicative of a need for searching for objective indicators (except for tuberculin diagnosis and history data) to identify the disease just before registration as a risk group. The practical value of chemotherapy for latent tuberculosis infection in the megapolis requires studies and evidence-based results. Preventive chemotherapy is currently the priority in preventing tuberculosis for individual risk groups (among the HIV-infected and those who are from tuberculosis infection foci).

[Criteria for clinical recovery and the evaluation of the efficiency of treatment in patients with respiratory tuberculosis in Moscow].

Criteria for clinical cure have been analyzed and the efficiency of treatment evaluated in patients with respiratory tuberculosis in Moscow. If today's official criteria for the efficiency of treatment have been ascertained to preserve in treating the first detected patients, a phthisiological service will completely lose an objective control of this section of work in several years. The only criterion that gives some idea of the results of treatment in first detected patients is currently to transfer them to dispensary register group III. However, when the results of interim treatment stages are unknown, conditions are created for utter arbitrariness in the time of the transfer (this happens at present). It is necessary to hold today's existing major criteria (cessation of bacterial isolation and closure of decay cavities) for evaluating the efficiency of treatment in first detected patients (who are largely inpatients) and to add one more criterion (disappearance of Xray signs of active tuberculosis manifestations); moreover, the magnitude of major or minor residual tuberculous changes should be, of course, taken into account after a basic course of chemotherapy.

[The tuberculosis monitoring system in Moscow].

The existing need for objective assessing methods of different reform strategies in the health care system and of the epidemic situation has resulted in the setting-up of monitoring systems as the most efficient and rapid tool to solve health care problems on the evidence basis provided that the primary data are highly valid. Clinical epidemiological methods with monitoring results kept in mind make it possible to search for the optimum approaches to achieving a qualitative, accessible, and effective program for health care delivered to the population. The tuberculosis monitoring system to be introduced in Moscow can pool an information flow at the urban level, furnishes an opportunity to analyze and assess the activities of a phthisiological service, makes it possible to obtain pooled data on areas, to assess the epidemic situation and tuberculosis-controlling work, and to work out and implement antiepidemic measures.